Nature
What the needs are, their effects, and the interventions required to manage them.
NHS Continuing Healthcare · Wales
Could the NHS in Wales have been responsible for the care fees?
Continuing NHS Healthcare in Wales is fully funded by the NHS where a person’s primary need is a health need. It is not means-tested, and the decision turns on the reality of the person’s needs — not their savings, property or diagnosis.
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The important Wales difference
In Wales, Continuing NHS Healthcare is administered through Local Health Boards (LHBs), not the Integrated Care Boards used in England. The Welsh Government’s national framework governs assessment, eligibility and review.
Who can qualify?
An adult can qualify where their overall needs amount to a primary health need. The assessment considers the nature, intensity, complexity and unpredictability of those needs. No diagnosis — including dementia, Parkinson’s or stroke — qualifies automatically.
Intensity
How severe and frequent the needs are, including the quantity and continuity of support required.
Complexity
How different needs interact and the skill needed to manage them safely.
Unpredictability
How much needs fluctuate, the risks involved, and what can happen if the response is delayed.
If the Local Health Board refused funding
Wales has its own appeal timetable. You should normally notify the LHB that you intend to appeal within 28 days of being told the eligibility decision, and submit the written appeal within six months. The process begins with local review and can progress to an Independent Review Panel.
If the dispute remains unresolved after review, the case can also be taken to the Public Services Ombudsman for Wales.
Already paid care fees? Do not assume the English retrospective rules apply.
In Wales, a retrospective CHC review may be requested where the LHB wrongly applied the criteria or where it should reasonably have been apparent that CHC should have been considered but no assessment was arranged.
The current Welsh system has a rolling cut-off: a retrospective claim should normally be made within 12 months of the end of the period being claimed for. Late claims may be considered only in exceptional circumstances.
What a retrospective review involves
The LHB can ask for evidence of the fees paid and proof that you have authority to act. The Welsh retrospective process examines the available records and chronology of need, with cases showing CHC triggers progressing to fuller review against the primary health need test.
- Care plans and risk assessments can be central evidence.
- GP, nursing and care-home records may show needs that were understated at the time.
- Family evidence can be crucial where records do not capture night-time needs, behaviour, risk or fluctuation.
- A successful review can lead to reimbursement for an eligible period.
A 2026 change: direct payments
From 1 April 2026, Welsh CHC policy was updated to reflect the NHS Direct Payments (Wales) Regulations 2026. Eligible adults can request direct payments for qualifying CHC arrangements, subject to the statutory rules and care-planning requirements.
Why use a specialist?
You can approach your Local Health Board yourself and there is no charge for applying. Specialist help is most valuable where there has already been a refusal, the needs are complex, important evidence is missing, or a case is moving into local review or an Independent Review Panel.
Our role is to analyse the evidence against the correct Welsh framework, identify where the assessment does not match the actual care needs, and present the case clearly. No outcome can be guaranteed.
This page provides general information about Continuing NHS Healthcare in Wales and is not legal advice about an individual case. Christodoulos Ltd (trading as Theodorous) is authorised and regulated by the Solicitors Regulation Authority, SRA 809508.
Start with four quick questions
Tell us where the care was provided, what the NHS has done so far and the broad pattern of needs. We will then ask for your contact details if the case is worth reviewing.
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